Prevalence and risk factors of halitosis in Japanese school children

Changes in halitosis value before and after Helicobacter pylori eradication: A single-institutional prospective study

BACKGROUND AND AIM

Although patients report either improved or worsened halitosis after Helicobacter pylori eradication therapy, such complaints are subjective. Only a few studies have objectively evaluated reports of changes in halitosis after H. pylori eradication; thus, this study aimed to investigate these changes after a successful H. pylori eradication.

METHODS

Between February 2015 and October 2018, 56 347 patients visited the clinic. Informed consent for participation in this study was obtained from 164 patients scheduled to undergo upper gastrointestinal endoscopy due to halitosis. Of the 91 patients with H. pylori infection, the halitosis values were evaluated as Refres breath (RB) values using a Total Gas Detector™ System and compared before and after successful H. pylori eradication, as confirmed with urea breath testing.

RESULTS

Among the 91 patients treated, 77 patients were successfully eradicated of H. pylori and had their Refres values measured (21 men and 56 women; mean age, 64.2 ± 11.5 years, including 10 smokers); among these 77 patients, 27 showed RB values of > 60. Their RB values significantly improved from 73.5 Â (95% confidence interval [CI], 64.1-82.9) to 59.4 Â (95% CI, 50.0-68.8) (P = 0.038). Of the 30 patients who could be followed up for > 2 years after successful H. pylori eradication, 8 with an RB value ≥ 60 showed significant RB value improvements from 77.9 Â (95% CI, 59.4-96.4) to 30.1 Â (95% CI, 11.6-48.6) (P = 0.0016).

CONCLUSIONS

Helicobacter pylori eradication therapy could improve halitosis, and such improvement could be maintained even 2 years after successful eradication.

The aetiology and associations of halitosis: a systematic review

INTRODUCTION

Halitosis is a term that refers to an unpleasant or foul odour originating from the oral cavity that can be caused by either intra-oral or extra-oral factors. Despite the fact that halitosis has multifactorial aetiology, intra-oral factors play a significant role in the majority of cases.

AIM

This systematic review assesses halitosis's intra-oral and extra-oral associations.

METHODS

An electronic search through MEDLINE (PubMed), Google Scholar, and the Wiley Online Library was conducted to identify relevant manuscripts. A keywords-based search was performed, using the terms "halitosis," "bad-breath," and "oral malodour causes and aetiology." Articles published from January 2014 to December 2020 were included. We selected studies evaluating the intra-oral and extra-oral factors that induce oral malodour, as well as the factors associated with systemic diseases.

RESULTS

Eighty to ninety percent of halitosis is caused by intra-oral factors, with coated tongue, periodontal diseases, and poor oral hygiene practices being the principal factors. Ten to twenty percent of halitosis is induced by extra-oral factors associated with systemic diseases.

CONCLUSIONS

Multiple factors can cause halitosis, but most of the aetiology is intra-oral. Increased medical awareness is needed to determine the actual pathophysiological process of oral malodour in otherwise healthy individuals.

Knowledge and perception of parents regarding halitosis in their children in Saudi Arabia

Objective

To evaluate parents’ knowledge about halitosis, and to compare parents’ perception of halitosis in their children to the presence of halitosis clinically.

Methods

Children between 3 and 8 years attended to Dental University Hospital, King Saud University, were screened. Children satisfying inclusion criteria and their parents agreed to participate were included. Questionnaires regarding parents’ knowledge and perception about halitosis in their children were filled by attending parents. Then, the assessment of halitosis in the participating children carried out by portable gas chromatograph device (OralChroma^TM).

Results

A total of 67 children (44 girls and 23 boys) were included in this study with a mean age of 5.3 years (SD = 1.7). The majority of the questionnaires (n = 44, 65.7%) were filled by accompanying fathers. One in two (52.2%) parents obtained high knowledge score about halitosis. Parents’ knowledge was significantly associated with the mean age of the children (P = 0.02). Thirty-nine (58.2%) parents perceived halitosis in their children. Gender, child’s age, parents’ education level, or family income were not associated with parents’ perception of halitosis. Halitosis was detected clinically in 58 children (86.6%). Thirty-eight (57%) of parents’ perception of halitosis was in consistency with OralChroma^TM readings; however, there was no significant association between parents’ perception and the OralChroma^TM score.

Conclusion

Half of the parents had good knowledge about halitosis and 6 in 10 parents perceived halitosis in their children which is quite less than the presence of halitosis detected clinically. Moreover, parents’ perception was not associated with the OralChroma^TM score.

Halitosis in Children Undergoing Full Mouth Rehabilitation under General Anesthesia

Interventions and management modalities of pediatric halitosis have been suggested in the literature, however, the effect of full mouth rehabilitation (FMR) under general anesthesia (GA) on pediatric halitosis was not reported. Therefore, the present study was conducted to investigate parents' perceptions of their child's halitosis before and after FMR under GA; and to evaluate the effect of FMR on clinical halitosis. Fifty-seven children between 3-8 years old, scheduled for FMR under GA, were included after satisfying the inclusion criteria and upon parental consent. Parents' perception of halitosis in their children was evaluated using a standardized questionnaire and a breath sample was collected to assess the level of volatile sulfur compounds (VSCs) using OralChroma^TM before and after FMR under GA. Sixty percent (n = 34) of the parents perceived halitosis in their children before FMR and about 80% (n = 27) of them reported improvement in halitosis after FMR. Clinical halitosis was detected in 84.2% (n = 48) of the sample before treatment. A statistically significant reduction in halitosis was found in 56.3% (n = 27) of the children after treatment (p < 0.001). In conclusion, majority of parents perceived an absence or reduction of halitosis in their children following FMR and significant improvement of clinical halitosis.

Relationship between Insufficient Sleep and Bad Breath in Korean Adolescent Population

This cross-sectional study sought to evaluate the association between insufficient sleep and bad breath among Korean adolescent population. It was based on the 13th Korea Youth Risk Behavior Web-Based Survey (2017). From 64,991 participants (aged 13-18 years), the final participation rate in the survey was 95.8% (62,276 participants; 31,624 boys and 30,652 girls). A complex sample logistic regression was performed to identify the relationship between insufficient sleep and halitosis, after adjusting for all covariates. In Model II for estimating the adjusted odds ratio (AOR) for general characteristics, students who answered "not at all sufficient", indicating insufficient sleep, were at higher risk of bad breath than those who answered "completely sufficient" (AOR = 2.09, 95% confidence interval, CI = 1.91-2.30). In Model III, for estimating the AOR adjusted for all covariates, students who answered "not at all sufficient", indicating insufficient sleep, were at higher risk of bad breath than those who answered "completely sufficient" (AOR = 1.47, 95% CI = 1.33-1.83). It is necessary for families and schools to have health education lessons that recognize insufficient sleep among adolescents may be a cause of bad breath and therefore optimal sleeping habits and oral health behaviors should be promoted.

The Underestimated Problem of Intra-Oral Halitosis in Dental Practice: An Expert Consensus Review

Approximately 90% of halitosis cases originate within the oral cavity (intra-oral halitosis). With a focus on intra-oral halitosis, this narrative review article provides a current summary of the epidemiology, diagnosis and management of halitosis and discusses practical considerations for healthcare professionals (HCPs), including dentists, dental hygienists, general practitioners, community pharmacists, nurses and medical specialists. MEDLINE and PubMed were searched up to 31 December 2019. Additional information was sourced from reference lists of relevant published literature. Full-text articles which reported on the epidemiology, diagnosis and management of halitosis were considered for inclusion. Halitosis affects substantial numbers of individuals globally and is an underestimated problem in dental practice. Current estimates of the prevalence of halitosis, in addition to diagnostic methods and management considerations for halitosis, are discussed. Although not a life-threatening condition, halitosis has a significant impact on patients’ quality of life and can result in psychological consequences including social, professional and affective limitations. Using a simple step-wise approach for diagnosis and treatment, dentists and dental hygienists are ideally placed to respond to an initial consultation for halitosis.